Organization
JEFFERY W. EDSTROM
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY J MEIER CPC (BILLING MANAGER)
(307) 674-5123
Entity
Organization
Contact information
Practice address
1524 W 5TH ST, SHERIDAN, WY 82801-2707
(307) 672-7874
Mailing address
PO BOX 767, SHERIDAN, WY 82801-0767
(307) 674-5123
(307) 674-5230
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
23492.0828
WY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1164427274
—
WY
Enumeration date
01/30/2014
Last updated
06/03/2014
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